Medicare Covers Kidney Disease Patient Ed

Two new HCPCS Level II codes allow qualifying physicians and hospitals to be reimbursed for kidney disease patient education services provided to Medicare patients in 2010.

Effective Jan. 1, kidney disease patient education services are a covered Medicare benefit for patients with Stage IV chronic kidney disease (CKD), as indicated in the medical record by a severe decrease in the glomerular filtration rate (GFR) to that of 15-29 mL/min/1.73 m². A referral from the physician managing the patient’s condition should also be obtained and documented.

Who Qualifies

According to Centers for Medicare & Medicaid Services (CMS) Transmittal 117, Change Request 6557:

  • Medicare will cover up to six KDE sessions in a patient’s lifetime.
  • Sessions should be billed in 1-hour increments. A session must be at least 31 minutes in duration.
  • KDE services must be furnished by a “qualified” person. That is:
    • A physician, physician’s assistant, nurse practitioner or clinical nurse specialist;
    • A hospital, critical access hospital (CAH), comprehensive outpatient rehabilitative hospital (CORF), home health agency (HHA), or hospice located in a rural area; or
    • A hospital or CAH paid as if it was in a rural area.

New Codes to Report

CMS issued two new HCPCS Level II codes hospitals and physicians can use to report covered KDE services in 2010. Note, however, that Medicare will not reimburse both the hospital and physician for KDE services conducted on the same day for the same Medicare patient(s).

Report HCPCS Level II code G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour to report KDE for individual sessions. Report HCPCS Level II code G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per, per session, per one hour for sessions consisting of two or more people—not all of which have to be Medicare patients (some may be family members, for example).

To support a KDE service code, include ICD-9-CM diagnosis code 585.4 Chronic kidney disease, Stage IV (severe).

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One Response to “Medicare Covers Kidney Disease Patient Ed”

  1. Marilyn Harrison says:

    May we bill G0421 when ONLY the family of the patient is present for CKD education? The patient will not attend the session due to disabilities.

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